Jeremy Solly (JS): Welcome to the HealthChangers podcast, presented by Cambia Health Solutions, where we share real stories of health care transformation from those experiencing it and those helping to make health care more personalized. I'm your host, Jeremy. Today we'll hear a conversation between Leslie from Cambia and the health startup company, mPulse Mobile. This will be the first in a mini-series where Leslie will interview various entrepreneurs and tech startup companies in the health care space. Welcome, Leslie.

Leslie Constans (LC): Thank you, Jeremy.

Trends in Digital Health

"Last year there was upwards of 4.2 billion dollars of venture capital invested in digital health."

JS: Health care we know is notoriously complex, and over the last decade or so, we've seen a lot of new entrants into the health care space. I think we even saw last year there was upwards of 4.2 billion dollars of venture capital invested in kind of this entrepreneur space of health care. What are the conditions, why is this happening?

LC: Yeah, actually that report you mentioned it comes from Rock Health. In 2016 that venture capital went into funding over 300 companies in this space. With the HealthChangers podcast, we thought this would be a perfect opportunity to reach out and talk with some of those companies, the players, the people who whether they were in health care or outside of health care, they saw a pain point, they had a frustration, they recognized a problem. We want to delve into the innovative thinking behind the solutions and the companies that they've formed to solve those problems.

JS: What are they? Are there key areas in health care where we're seeing a lot of these companies either be created or invested in?

LC: Absolutely. We're seeing areas like analytics and big data, wearables, telemedicine, even population health. Part of the series will be delving into those stories and the people behind them who are tackling these problems and solving consumer issues for health care consumers.

JS: That's great. Thanks, Leslie. We can't wait to hear more about each one of these intrepid companies and how they're transforming health care.

Mobile Engagement with mPulse Mobile

"Consumers have raised their hand and said that mobile is their preferred channel for engagement."

LC: I was reading on your blog that 94 percent of adults own a mobile phone and 90 percent of people read their texts. Clearly people are using this as a primary source of communication, aren't they?

CN: Whether we're talking about health care, we're talking about retail, banking, the gaming industry, whatever that may be is that consumers have raised their hand and said that mobile is their preferred channel for engagement. Even those that are engaging mobiles at about 97 percent are opening and engaging those messages within about three minutes, so you've really got the most accessible channel on the planet today.

Expectations for Mobile Options

"Patients were asking, 'Why aren't you guys texting me information?'"

LC: Do you find, are consumers asking their health care providers or their plans for this kind of mobile engagement? What do your users say?

PM: A funny story—one of our great customers that we've been working with for over three years is Mayo Clinic, one of the most advanced health systems around. Their customers, their patients were asking, "Why aren't you guys texting me information about my appointments or my procedures? Why am I getting a robocall or why am I getting an email? I don't use those channels frequently, it's so much easier if you just send me a text message."

They got a lot of feedback from their patients asking for this. Once they started using it the patients were telling their doctors how much they love it. We definitely see a lot of consumer demand coming through the providers and the health plans asking for this technology, asking for this capability to get text messages because that's how they like to interact. It's easy, it's at their convenience, and they're very satisfied by it.

CN: Just one point there is I would say if I can describe with one word, it's “expectation.” It’s that consumers really expect to have that ability to engage digitally. When they go to a provider or health care system and they don't have that ability, they're really discouraged. From a patient or member satisfaction it's really sort of a necessary process today.

The Right Information at the Right Time

"Whatever I need to know to take care of my health, I'm going to get that through bite sized chunks of information."

LC: How do you both describe mPulse Mobile for people who don't necessarily work in health care? How do you describe what you're doing for people?

PM: mPulse is all about simplifying communications between health care organizations and their consumers. It's about helping anybody get the right information at the right time. When it's time to go see my doctor, I'm going to get a text message that says, "Hey Paige, it's time to see Dr. Smith. Please be sure to be there tomorrow at 11:15," and they'll give me the location. They'll also ask me if I want to reschedule or cancel so it's going to make it really simple for me to know about my appointments or plan benefits and service. Whatever I need to know to take care of my health, I'm going to get that through bite sized chunks of information through text messaging.

LC: Can you give some examples of those bite sized chunks of information or those conversations that people are having? Maybe you call them applications. How are people using this technology?

PM: Yeah, absolutely. I'll give a personal anecdote. I had a very minor outpatient surgical procedure a number of years ago. When I walked out of the hospital I was given a stack of papers with instructions of what I was supposed to do over the next two weeks to a month, post-surgery. Well, to keep those documents safe, to keep referring to them, to know what to do, when, was extremely overwhelming for me.

We've trimmed that concept down to a solution where we're sending out very targeted text messages to patients based on the surgery they had and any aspects of their health so that they know when to start taking the medication, when to check the bandage, when to set their follow-up appointment. Checking in on any potential challenges or issues post-surgery, so that if there is a problem, the doctors are aware immediately to reduce any readmissions. Really helping turn that stack of papers into bite-sized chunks of information that help the individual take the best care of themselves post-surgery.

CN: Let me go in to add just a few ... we’ve got a broad base. I think that's a great personal example. We would look at things like care, medication adherence, operational messaging, the pre- and post-procedure communications, preventative services, new member onboarding. There are over 200 use cases that we have in production today that are helping solve problems within this health care ecosystem. I think that again sort of underlines the fact that there is a high demand and expectation for consumers that want to engage in health care on digital channels.

The Consumer Journey Through Health Care

"What we really look at is creating these meaningful dialogues that are tailored and relevant to drive healthy behavior change."

LC: I think what you're telling me is you're helping to ease the patient on the consumer journey through the health care system. How do you think that fits into the larger discussion around health care today and where the industry is going and needs to go?

CN: If you look from the last probably six or eight years or so, there's been a lot of talk about the consumerization of health care. From the creation of consumer-driven health plans, creating these 360 view of the consumer. Even creating roles like a Chief Consumer Officer or a Chief Experience Officer within a health plan are pretty fundamental changes that the industry's really phased in. It really helps you understand the trend and the importance of really them pivoting in this new world. Again, consumers are expecting that kind of engagement already and so what we really look at is creating these meaningful dialogues that are tailored and relevant to drive healthy behavior change.

Real World Success Stories

"With the mPulse solution we had a 15 percentage point increase in people refilling their prescriptions."

LC: Are there any success stories you could share from your clients or ultimately their patients or members that you've heard that really bring this point home around engaging people where they are in their health care journey and helping them along the way rather than burdening them with paper and processes?

PM: Yeah. One example that immediately comes to mind is work we're doing with Kaiser Permanente around medication adherence. I need to ensure people are taking the right medications, the medications that are going to help them with their health, but also understanding why they might have stopped taking it. We're doing a project with the Medicare population. I know we know that everybody, all the millennials are texting, but we also have found that 92 percent of people over the age of 50 text on a regular basis. Patients at Kaiser were not refilling their chronic condition medications so we did a three-month study with this population adding mPulse's interactive tailor text dialogues to improve refill rates for this population.

A big part of that was understanding, if they didn't refill their medication, why was that? Then making sure we were delivering tailored dialogues to help improve their refill rates. What we found is with the mPulse solution we had a 15 percentage point increase in people refilling their prescriptions, which is a marked improvement, very significant. That was a great example.

LC: Yeah, that is a really good story.

CN: I have a few other ones as well specific to, just to show you the diversity I think from a applying success. Medtronic is one of the largest medical device companies on the planet today. You think about how many people builds basically technology for the health care setting used by consumers leveraging our technology to manage order refills for their patients to actually make that process easier so that people can get the services they need, providing the education and guidance along with that. If someone's not sure how to use one of the devices or they're in need they can literally text in and have this messaging dialogue to make that happen.

Ieso Health is a behavioral health company in the digital space that leverages our technology to actually get people to enroll in behavioral health programs. Through a quick survey they can learn and understand what's the survey about, would it be helpful to them, and then driving that through. We're I think driving about 66 percent of the registrations into that program via digital modalities.

Moving from Corporate to Startup

"There is absolutely more money flowing into health care than ever before."

LC: Well, as we wrap up today's conversation I wanted to end with a question or two for you, Chris, about your role as an entrepreneur in mPulse. You really spent a majority of your career at a large health care enterprise. I'm just curious if you could share a little bit about the leap when you went from enterprise to a startup.

CN: Absolutely. It was a big transition, sort of later in life after roughly 15 years in a large system. Starting out there in the innovation center, moving through the organization, learning about health care and the plan and benefit side of the shop. The history before that is that actually I have my MBA in entrepreneurship and had another startup company in the early days and so it was sort of ... That was the beginnings of my career was in the startup space and launched a company that had an exit, gosh, probably 20 years ago and then shifted into large enterprises with Verizon and Humana and then sort of coming back to that. It's always interesting in life how we come full circle in that space.

LC: 20 years is a long time. What's changed in the entrepreneurial landscape since your first experience in startup?

CN: There is absolutely more money flowing into health care than ever before. Average deal sizes are 10 to 12 million. People understand how complex health care is and it's truly for companies to be successful.

Advice for Other Entrepreneurs

"Find that one or two strategic clients to collaborate with and really build out the solution."

LC: As you've gone through your journey and it sounds like, Chris, you started out as an entrepreneur a few years back and have returned to your roots, what advice would you give other innovators who are either considering creating a solution for the health care space or already have started their venture?

CN: The advice that I would give to other innovators and entrepreneurs is to find that one or two strategic clients to collaborate with and really build out the solution. Get some success under their belt with that particular client and then that partner then can help create those case studies and really validate that experience before they go to raise capital or to go to do other things. I think that if they've got that one really large chance in the sector then other companies that really look up to that particular partner will fall in line very, very quickly from a growth perspective for them as well.

LC: What are some of the challenges of being an entrepreneur or a startup and how do you overcome those?

PM: I think, if I think about one of the challenges of being a startup is helping educate the market on what you do. The mPulse Mobile Solution is something that people don't have, they don't know about yet. A big key component of my marketing strategy is educating the market on the value and the benefits. We know people are attached to their mobile phones. How do you use that to your benefit in connecting with your consumers?

Dispelling Urban Legends

"Some of those probably had some bearing or truth 15 years ago but the market's evolved, the regulation's evolved."

CN: The last thing I'd add on that question as well is I would say, Paige, respond with the education, the knowledge sharing. A lot of the work we do is to provide guidance in the sector and I would say it's all around these urban legends that exist. It's an interesting space where there's a lot of partners that you connect with who say, "We want to do something in digital health but we've been told by Compliance it's illegal to send messaging to our patients." Some of those probably had some bearing or truth 15 years ago but the market's evolved, the regulation's evolved and there's some really tremendous success stories out there with those who embrace the regulations, embrace the technology.

LC: I like that analogy. The urban legends of the past are no longer. This has been a fascinating conversation with Chris Nicholson and Paige Mantel from mPulse Mobile. I want to thank you both so much for your time today and sharing the journey of an entrepreneurial startup in health care today. I really appreciate you being a part of our show today.